Topics in Geriatrics: Home Adaptations for Older Adults
Objectives: The Objectives of this page are to:
Learn about fall risk and potential complications
Learn about common fall hazards
Learn about home adaptations to reduce falls during a home assessment
Learn about design features for older adults with disabilities
Learn about resources, guides, and places to assist with environmental adaptations
Fall Risk: 1 out of 3 adults over the age of 65 fall each year1. Falls are the leading cause of fatal injuries in older adults, resulting in nearly 25,000 deaths annually1. Falls can result in fractures to all parts of the body and can cause traumatic brain injuries with long lasting effects. According to the CDC, falls alone cost nearly $34 billion dollars annually, increasing medical costs for everyone1. There are many potential risk factors for falls for older adults. Older adults with significant muscle weakness in their legs are more prone to falls. Decreased sensation in your feet, diminished vision, and decreased balance also increase your chances of falling. Taking multiple medications, in particular medications that affect blood pressure can lead to falls as well2. With all these factors in mind, one of the easiest risk factors for falls to control is to alter the patient’s home environment and make their home as accessible as possible. Addressing fall hazards and making the home accessible with improve patient’s quality of life and independence.
Common Fall Hazards3,4
Uneven Surfaces
Slippery Surfaces
Changes in surface texture, appearance, or heights
Thresholds
Handrails not present
Inadequate lighting
High or Narrow Steps
Objects placed too high or too low
Rugs
Gates
Seating/furniture arrangements
Cords on the floor
Bathmats
Improper footwear
Home Assessment Suggestions4 When performing a home assessment with a patient, a therapist should try to mitigate as many of the fall hazards presented above. Here are some suggestions to present to patients to help make their homes safer.
Arrange lighting source or light switches at entry of all rooms of home
Place lamp and telephone on nightstand of bed
Install lighting at front and back doors and around landings
Bed height not too low or too high
Have clear pathways around furniture
Place cords out of walkways and tape them to the floor if unable to remove from walkway
Place commonly used items/food/etc between waist and eye level
Remove throw rugs or place non-slip backing to them
Ensure carpets are secured to floor
Reduce threshold heights when possible
Install grab bars inside of tub and near toilets
Install hand rails on both sides of stairs
Repair steps if necessary
Resources for “Fall Proofing” Homes for Older Adults
Below are guides that can be used by therapists, as well as given to patients for reducing falls in their home.
Environmental Adaptations for Older Disabled Adults5-7
For patients that have more severe functional limitations, more significant home modifications might be necessary. Patients who use assistive devices like rolling walkers or wheelchairs might require alterations to entranceways, bathroom and kitchens, and other furniture configuration changes to make them as functionally independent as possible. Additions to the home like a wheelchair accessible ramp, handrails, grab bars may also be pertinent. Here are ADA guidelines for wheelchair accessibility as well as suggestions for home modifications that should be taken into account when assessing a home:
Doors and Hallways
32” width door minimum
36” hallway minimum
Handrails
1.25-1.5” in diameter and mounted 1.5” from the wall
34-38” high mounted on both sides
Wheelchair Ramp
1:12 Rise to length ramp slope ratio
5’ x 5’ landing at top and bottom of ramp
30 foot run max before needing a turn or rest platform
Kitchen
Countertop Height
Minimum of 28” but no higher than 34”
24” height from floor minimum and 30” width for wheelchair clearance
Sink
5-6.5” depth
Cabinets
15” from countertop
Appliances with front facing knobs
Stove top controls placed on front or below to avoid burners
Roll- In Shower
36” wide by 60” deep minimum
60” wide minimum when facing the shower head
Grab Bars
Side Wall
Located 12” max from rear wall and extending 54” minimum from rear wall
42” long minimum
Rear Wall: 24” long minimum centered
Resources for Home Modifications One of the biggest struggles for patients when considering home remodeling or adaptations is the cost and availability of help.8 Below are resources listed to assist with cost as well as organizations that assist with making homes accessible for individuals with disabilities.
You, Liming,R.N., M.S.N., Deans, Cecil,PhD., R.N., Liu, Ke,R.N., M.S.N., Zhang, Meifen F,R.N., M.S.N., & Zhang, Jun,R.N., M.S.N. (2004). Raising awareness of FALL RISK among chinese older adults: USE OF THE HOME FALL HAZARDS ASSESSMENT TOOL. Journal of Gerontological Nursing, 30(6), 35-42. Retrieved from http://search.proquest.com/docview/204198011?accountid=14868
Clemson, L., Fitzgerald, M. H., Heard, R., & Cumming, R. G. (1999). Inter-rater reliability of a home fall hazards assessment tool. The Occupational Therapy Journal of Research, 19(2), 83-100. Retrieved from http://search.proquest.com/docview/907243762?accountid=14868
Duff, J. M. (2010). Reducing the number of environmental hazards in the homes of community dwelling elderly: A comparison of approaches to fall prevention via environmental assessment and modification (Order No. 3408273). Available from ProQuest Dissertations & Theses A&I. (610025201). Retrieved from http://search.proquest.com/docview/610025201?accountid=14868
Objectives:
The Objectives of this page are to:
Fall Risk:
1 out of 3 adults over the age of 65 fall each year1. Falls are the leading cause of fatal injuries in older adults, resulting in nearly 25,000 deaths annually1. Falls can result in fractures to all parts of the body and can cause traumatic brain injuries with long lasting effects. According to the CDC, falls alone cost nearly $34 billion dollars annually, increasing medical costs for everyone1. There are many potential risk factors for falls for older adults. Older adults with significant muscle weakness in their legs are more prone to falls. Decreased sensation in your feet, diminished vision, and decreased balance also increase your chances of falling. Taking multiple medications, in particular medications that affect blood pressure can lead to falls as well2. With all these factors in mind, one of the easiest risk factors for falls to control is to alter the patient’s home environment and make their home as accessible as possible. Addressing fall hazards and making the home accessible with improve patient’s quality of life and independence.
Common Fall Hazards3,4
Home Assessment Suggestions4
When performing a home assessment with a patient, a therapist should try to mitigate as many of the fall hazards presented above. Here are some suggestions to present to patients to help make their homes safer.
Resources for “Fall Proofing” Homes for Older Adults
Below are guides that can be used by therapists, as well as given to patients for reducing falls in their home.
http://nihseniorhealth.gov/falls/homesafety/01.html
http://www.a4aa.com/Fall_Proofing_Your_Home_FINAL.pdf
Environmental Adaptations for Older Disabled Adults5-7
For patients that have more severe functional limitations, more significant home modifications might be necessary. Patients who use assistive devices like rolling walkers or wheelchairs might require alterations to entranceways, bathroom and kitchens, and other furniture configuration changes to make them as functionally independent as possible. Additions to the home like a wheelchair accessible ramp, handrails, grab bars may also be pertinent. Here are ADA guidelines for wheelchair accessibility as well as suggestions for home modifications that should be taken into account when assessing a home:
Doors and Hallways
Handrails
Wheelchair Ramp
Kitchen
Roll- In Shower
Grab Bars
Resources for Home Modifications
One of the biggest struggles for patients when considering home remodeling or adaptations is the cost and availability of help.8 Below are resources listed to assist with cost as well as organizations that assist with making homes accessible for individuals with disabilities.
References